《2020 ACOG实践简报：孕龄≤70 d药物流产(No.225)》解读

doi:10.3877/cma.j.issn.1673-5250.2022.03.005

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (03) : 275 -281. doi: 10.3877/cma.j.issn.1673-5250.2022.03.005

标准·方案·指南

《2020 ACOG实践简报：孕龄≤70 d药物流产(No.225)》解读

王巍¹, 李顺双², 刘刚³^,^†(

)

¹河南省人民医院、郑州大学人民医院妇产科，郑州　450003
²郑州大学第一附属医院妇产科，郑州　450052
³河南省人民医院、郑州大学人民医院临床医学研究中心，郑州　450003

收稿日期:2021-09-10 修回日期:2022-03-06 出版日期:2022-06-01
通信作者: 刘刚

Interpretation to Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225

Wei Wang¹, Shunshuang Li², Gang Liu³^,^†()

¹Department of Obstetrics and Gynecology, Henan Provincial People′s Hospital, People′s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
²Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
³Department of Clinical Research Center, Henan Provincial People′s Hospital, People′s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China

Received:2021-09-10 Revised:2022-03-06 Published:2022-06-01
Corresponding author: Gang Liu
Supported by:
National Natural Science Foundation of China(U1204821); Natural Science Foundation of Henan Province(182300410358)

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王巍, 李顺双, 刘刚. 《2020 ACOG实践简报：孕龄≤70 d药物流产(No.225)》解读[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(03): 275-281.

Wei Wang, Shunshuang Li, Gang Liu. Interpretation to Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(03): 275-281.

药物流产(MA)是早孕期避孕失败的补救措施，主要药物为米非司酮和米索前列醇，二者联合使用，可使早孕期孕妇完全终止妊娠率达到90%。但是，MA导致的患者阴道流血时间长、量多，甚至阴道大流血，而需采取急诊刮宫术治疗等，尚未被彻底解决。如何安全、有效终止早孕期妊娠，保护女性生殖健康是目前国内外该领域的研究重点。美国妇产科医师学学会(ACOG)发布的《2020 ACOG实践简报：孕龄≤70 d药物流产(No.225)》对早孕期孕妇终止妊娠，具有重要指导作用。笔者拟就该简报对MA用于孕龄≤70 d孕妇的临床效果评估，MA用药方案、禁忌证、适应证，MA前咨询和检查，MA疼痛管理，MA后观察、预防性抗菌药物使用、随访管理、避孕措施9个方面基于循证医学推荐进行解读。

关键词: 流产，人工, 妊娠初期, 人工终止妊娠术，早孕期, 药物流产，早孕期, 米非司酮, 米索前列醇, 生殖健康，育龄女性, 指南解读

Medication abortion (MA) is a remedial measure for contraceptive failure in early pregnancy. The main medication regimen includes mifepristone and misoprostol, and rate of complete termination of pregnancy in first trimester could be about 90% by combination of them. However, problems, such as patients with vaginal bleeding caused by MA have a longer duration, a larger volume, or even a vaginal hemorrhaged badly, and need for emergency curettage than those of artificial termination of early pregnancy have not been completely solved yet. At home and abroad, how to safely and effectively terminate early pregnancy and protect women′s reproductive health are researched and focused in this field. American College of Obstetricians and Gynecologists (ACOG) released the Medical Abortion Up to 70 Days of Gestation, 2020 ACOG Practice Bulletins, Number 225 plays an important guiding role in terminating early pregnancy. This paper intends to evaluate and interpret the 2020 ACOG practice bulletins above mentioned by recommendation level evidence-based from 9 aspects, including scheme, contraindications and indications of MA, consultation and medical examination before MA, pain management of MA, and observation, preventive antibiotics, follow-up management and contraceptive measures after MA.

Key words: Abortion, induced, Pregnancy trimester, first, Artificial termination of pregnancy, early pregnancy, Medication abortion, early pregnancy, Mifepristone, Misoprostol, Reproductive health, women of childbearing age, Interpretation, guideline

表1 美国FDA批准的药物流产方案与WHO推荐方案比较

用药方案		米非司酮(mg，给药方式)	米索前列醇(μg，给药方式)	用药间隔时间
联合用药方案(首选)
	FDA批准方案	200(口服)	800(口服)	24~48 h
	WHO推荐方案	200(口服)	800(阴道、舌下或口腔含服)	24~48 h
单药方案(备选)		/	800(阴道、舌下或口腔含服)	1次/3 h×(1~3次)^a

表1 美国FDA批准的药物流产方案与WHO推荐方案比较

用药方案		米非司酮(mg，给药方式)	米索前列醇(μg，给药方式)	用药间隔时间
联合用药方案(首选)
	FDA批准方案	200(口服)	800(口服)	24~48 h
	WHO推荐方案	200(口服)	800(阴道、舌下或口腔含服)	24~48 h
单药方案(备选)		/	800(阴道、舌下或口腔含服)	1次/3 h×(1~3次)^a

表2 米非司酮(口服，200 mg)联合米索前列醇不同序贯用药方案对不同孕龄患者的完全终止妊娠率比较

米索前列醇给药途径/剂量(μg)	米索前列醇给药间隔时间(h)	不同孕龄患者的完全终止妊娠率(%)
米索前列醇给药途径/剂量(μg)	米索前列醇给药间隔时间(h)	≤49 d	50~56 d	57~63 d	64~70 d
口服给药/800	24~48	98.1	96.8	94.7	92.7
阴道给药/800	24~72	98.3~99.7	95.3~98.6	95.1~98.3	94.9
阴道给药/800	6~8	97.1	94.2	95.2	N/A
阴道给药/800	0~0.25	95.5~95.7	93.7~94.3	91.6~95.3	N/A
口服给药/400	24~48	95.4	N/A	94.8	91.9

表2 米非司酮(口服，200 mg)联合米索前列醇不同序贯用药方案对不同孕龄患者的完全终止妊娠率比较

米索前列醇给药途径/剂量(μg)	米索前列醇给药间隔时间(h)	不同孕龄患者的完全终止妊娠率(%)
米索前列醇给药途径/剂量(μg)	米索前列醇给药间隔时间(h)	≤49 d	50~56 d	57~63 d	64~70 d
口服给药/800	24~48	98.1	96.8	94.7	92.7
阴道给药/800	24~72	98.3~99.7	95.3~98.6	95.1~98.3	94.9
阴道给药/800	6~8	97.1	94.2	95.2	N/A
阴道给药/800	0~0.25	95.5~95.7	93.7~94.3	91.6~95.3	N/A
口服给药/400	24~48	95.4	N/A	94.8	91.9

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